Chest Trauma

Question 1

Pneumothorax

Answer 1

presence of air in the plural space - types include closed, open, tension, hemothorax of chylothorax.

Question 2

Tension Pneumothorax

Answer 2

neck vien distention, tracheal deviation away from the affected side, subcutaneous emphysema.
tachycardia, decreased or absent breath sounds, increased RR

Question 3

Hemothorax

Answer 3

signs of shock, decreased hemoglobin.
tachycardia, decreased or absent breath sounds, increased RR.

Question 4

Pneumothorax ABG findings

Answer 4

respiratory acidosis - low pH (<7.35) and high PaCo2 (>40)

Question 5

Pneumothorax Inter-professional care

Answer 5

may resolve spontaneously.
aspiration of plural space
insertion of chest tube (water-seal drainage)

Question 6

Fractured ribs

Answer 6

most common type of chest injury resulting from trauma (ribs 5-10 most commonly fractured because they are least protected by chest muscles).
pain (especially on inspiration) at the site of injury.

Question 7

Flail chest

Answer 7

results from multiple rib fractures, causing instability of the chest wall.
the affected (flail) area will move paradoxically to the intact portion of the chest during respiration.
prevents adequate ventilation of the lung in the injured area.

Question 8

Flail chest nursing management

Answer 8

initial therapy consists of adequate ventilation, admin of humidified O2 and crystalloid IV solutions, pain control.

Question 9

Chest Tubes and Plural Drainage

Answer 9

3 chambers - (1) collection chamber, (2) water-seal chamber, (3) suction control chamber (water suction and dry suction)

Question 10

Chest Drainage Complications

Answer 10

routine milking or stripping of chest tubes to maintain latency is no longer recommended because it can cause dangerously high intraplueral pressure and damage to plural tissue.
clamping of chest tubes during transport when the tube is accidentally disconnected is no longer advocated (risk for causing tension pneumothorax).

Question 11

Chest Tube Complications

Answer 11

chest tube malposition.
re-expansion pulmonary edema.
vasovagal response with symptomatic hypotension.
infection at the skin site.
pneumonia.
shoulder disuse (“frozen shoulder”)

Question 12

Chest Tube Removal

Answer 12

removed when lungs are re-expanded and fluid drainage has ceased. suction is discontinued gradually.

Question 13

Plural Effusion

Answer 13

types - (1) transudative and (2) exudative.
progressive dyspnea, decreased movement of the chest wall on the affected side, dullness to percussion and absent or decreased breath sounds over affected side.
empyema (pockets of puss that have collected inside a body cavity) - fever, night sweats, cough and weight loss.

Question 14

Thoracentesis

Answer 14

diagnosis and therapeutic purposes.
The patient sits on the edge of a bed and leans forward over a bedside table - 1000-1200ml of plural fluid is removed at one time.
rapid removal can result in hypotension, hypoxemia or pulmonary edema.

Question 15

Pleurisy

Answer 15

restrictive respiratory disorder - inflammation of the pleura

Question 16

Atelectasis

Answer 16

restrictive respiratory disorder - condition of the lungs characterized by collapsed airless alveoli.

Question 17

Trauma team in acute chest trauma

Answer 17

Nurses: perform initial assessment, monitor VS, admin medications, place foley catheter and NG tube, help with chest tube insertion, document.

Anesthesiologist: assist with airway control or establishing ventilation

Phlebotomist: draw blood and take specimens to laboratory.

X-Ray technician:
Respiratory Therapist:
Social services:
Pharmacist:

Question 18

Cullen Sign

Answer 18

bruising around the umbilicus.
can indicate intra-abdominal pain or retroperitoneal hemorrhage.